Home › Specialities › Glaucoma › Glaucoma surgery

Glaucoma surgery: trabeculectomy and YAG laser iridotomy

Most people with glaucoma keep their eye pressure under control with daily drops. For some eyes that is not enough, and the eye doctor advises a laser or an operation. This page explains the two procedures done at ReNew Vision Eye Hospital in Vasco: trabeculectomy, the standard glaucoma operation, and YAG laser peripheral iridotomy, the laser used for narrow (angle-closure) drainage angles. For glaucoma check-ups, drops and follow-up, see glaucoma check-up and treatment in Vasco.

When is glaucoma surgery needed?

Surgery is not the first step for most people. The eye doctor usually suggests a trabeculectomy when one or more of these is true:

• the eye pressure stays above your target level although you use your drops correctly
• the optic nerve or your side vision keeps getting worse at follow-up visits
• the drops cause allergy, redness or other side effects you cannot live with, or you find it hard to put them in every day
• the glaucoma is already advanced when it is first found, so the pressure has to come down further than drops can manage
• an angle-closure eye still has high pressure after laser iridotomy and drops

The decision also weighs your age, the state of the other eye, any cataract, and your general health. Apart from a sudden pressure attack, glaucoma surgery is planned, not rushed, so there is time for your questions.

What can glaucoma surgery do, and what can it not do?

Glaucoma surgery lowers the eye pressure to protect the optic nerve from further damage. It does not bring back side vision that glaucoma has already taken, and it does not make you see better than before. Sight in the operated eye is usually more blurred for the first weeks; the benefit is long-term.

What is a trabeculectomy?

A trabeculectomy creates a new, controlled outflow for the eye's fluid. Under local anaesthesia, the surgeon lifts a thin flap in the white of the eye near the top of the cornea and makes a small opening beneath it into the front chamber. Fluid now seeps out under the flap and collects in a shallow pocket under the thin outer skin of the eye, called a bleb. The bleb sits under the upper eyelid, out of sight. The flap is closed with fine stitches that can be loosened or removed later to fine-tune the flow. A medicine that slows healing is often applied during the operation, because the body tries to scar the new channel shut.

In Hindi, people often ask about the kala motia operation; this is the operation they usually mean.

How do I prepare for trabeculectomy?

• Tell the eye doctor about every medicine you take, especially blood thinners. Do not stop any of them on your own; the eye doctor and your physician decide together.
• Keep your blood sugar and blood pressure well controlled in the weeks before.
• Ask which glaucoma drops to continue and which to stop before the day.
• Arrange for someone to come with you. If getting to Vaddem is difficult, we can collect you from your home and drop you back, at zero cost to the patient.
• The eye doctor tells you beforehand whether you go home the same day.

What is recovery like after a trabeculectomy?

The eye is covered on the first night. From the next day you use antibiotic and anti-inflammatory drops for several weeks; glaucoma drops in the operated eye are usually stopped, but keep using any drops for the other eye. Expect a gritty, watery eye and blurred vision that clears gradually over some weeks. Spectacle power may change, so new spectacles are prescribed only after the eye settles.

For the first weeks:

• do not rub or press on the eye; wear the shield at night
• avoid heavy lifting, straining and bending with your head below your waist
• keep tap water, soap and dust out of the eye; no swimming
• in the monsoon, keep the eye away from rain splash and flood water and wash your hands before every drop

Why are there so many follow-up visits after trabeculectomy?

The first weeks decide how well the new channel works. You are usually seen the day after surgery, again within the week, and then every week or two for a couple of months. At these visits the eye doctor checks the pressure and the bleb, and may loosen or remove a stitch, or give other treatment to keep the channel open. After that, you return to regular lifelong glaucoma follow-up, with visual field tests as advised (these tests are done elsewhere; bring the results here).

What are the risks of trabeculectomy?

Like any surgery, trabeculectomy has risks, which the eye doctor goes through with you:

• Pressure too low in the early weeks, which can blur vision; it often settles, sometimes with extra treatment.
• Pressure too high again because the channel scars; drops, further treatment or another operation may be needed.
• A leaking bleb or bleeding inside the eye, usually short-lived.
• Faster growth of a cataract, which can be operated later.
• Infection, rare but serious, which can occur even years after surgery because the bleb is a thin, open pathway.

For as long as you have a bleb, remember: a red eye, a sticky discharge, pain or a sudden drop in vision in that eye must be seen the same day. Emergency eye care at ReNew Vision is available 24 hours; see eye emergency.

What is YAG laser iridotomy, and who needs it?

In angle-closure glaucoma, the iris lies too close to the drainage angle and can block it. This is more likely in long-sighted eyes, as we get older and the natural lens thickens, and in people of Asian origin, including Indians. The angle may close slowly, or suddenly in an attack with severe pain, redness, haloes and vomiting.

A YAG laser peripheral iridotomy (often shortened to YAG PI) makes a pinhole opening near the outer edge of the iris. Fluid then has a second route, the iris falls back, and the angle is much less likely to close. The eye doctor decides who needs it by examining the angle with a special lens; it may be advised for narrow angles before any damage, for angle-closure glaucoma, and for the second eye after an attack in one eye.

What happens during a YAG laser iridotomy?

You sit at the laser machine. A drop makes the pupil small, a numbing drop is put in, and a contact lens is placed on the eye to hold it steady. The laser takes a few minutes. Most people feel brief clicks and sometimes a short, sharp ache. Your pressure is checked again after about an hour, and you use anti-inflammatory drops for a few days. Vision may be hazy for the rest of the day.

What happens after an iridotomy?

Side effects are usually mild and short: a brief rise in pressure, slight inflammation or a small bleed from the iris. A few people notice a faint line or glare of light. An iridotomy prevents the angle from closing, but it does not always control the pressure on its own, so many people still need drops and regular glaucoma follow-up. Later, cataract surgery can widen a narrow angle further, and some eyes eventually need a trabeculectomy.

This laser is not the same as the YAG laser used for clouding after cataract surgery; for that, see YAG laser after cataract surgery.

Drops, laser or surgery: how is the choice made?

• Drops suit most open-angle glaucoma, as long as they control the pressure and you can use them daily.
• YAG laser iridotomy is for narrow or closed drainage angles, not for open-angle glaucoma.
• Trabeculectomy is for eyes in which drops, with or without laser, are not enough or not suitable.

Other glaucoma lasers and drainage implants (tubes and stents) are not done at ReNew Vision; if your eye needs one, the eye doctor refers you. Glaucoma is a special interest of our eye surgeon.

What decides the cost of glaucoma surgery?

We do not quote figures before an examination, because the cost depends on the procedure (laser or trabeculectomy), whether one or both eyes need treatment, whether cataract treatment is planned too, the drops needed afterwards, and the number of follow-up visits and adjustments. After your check-up you get a clear estimate for your own eye.

How do I book a glaucoma surgery consultation?

• Where: ReNew Vision Eye Hospital, 2nd floor, Pai Hospital building, Vaddem Merces Road, Vaddem, Vasco da Gama, Goa 403802. See timings and directions.
• When: Eye OPD Monday to Saturday, 4 pm to 7 pm. Emergency eye care: 24 hours.
• Call or WhatsApp: 072489 88039.
• Bring: all your eye drops, earlier eye reports and visual field results, a list of your medicines, and your spectacles.

Not sure about your eye pressure? Read what normal eye pressure means.

EMI facility is available for treatment and services above ₹30,000.

Questions patients ask

Does trabeculectomy hurt?

It is done under local anaesthesia, so you feel touch and pressure rather than sharp pain during the operation. Afterwards the eye feels gritty and sore for some days; ordinary pain tablets and the prescribed drops usually help.

Will glaucoma surgery improve my eyesight?

No. It lowers the eye pressure to protect the sight you still have. Vision already lost to glaucoma does not return, and sight in the operated eye is usually blurred for some weeks before it settles.

How long does recovery from trabeculectomy take?

Most of the healing happens over six to eight weeks, with frequent follow-up visits in that time. Light daily activities are usually fine within days; heavy work and swimming wait until the eye doctor says so.

Will I still need glaucoma drops after surgery?

Some people need no drops for years after a trabeculectomy, while others still need one or more. After a laser iridotomy many people continue their drops. The eye doctor checks this at every visit.

Is YAG iridotomy the same as YAG laser after cataract surgery?

No. Both use a YAG laser, but iridotomy makes a tiny opening in the iris to treat narrow angles, while the after-cataract laser clears a cloudy capsule behind the lens implant.

What does glaucoma surgery cost?

It depends on the procedure, one or both eyes, any cataract treatment, drops and follow-up visits. You get an estimate for your own eye after the check-up.

This page is general eye-health information, not personal medical advice. Your eye doctor advises you after examining your eyes.